Joining up health and social care in Sheffield

Wednesday 20 May 2015

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20 May 2015

Before pensioner Walter met community support worker Karen Dale he was being admitted to hospital regularly, and frequently calling emergency services.

But thanks to the support he now gets through Sheffield’s joined-up health and social care programme, Walter hasn’t been admitted to hospital for the last two years – and has also found a new friend in Karen.

“Karen understands me”, he said. “It’s lovely that she’s there if I need her.”

Karen, 55 from Gleadless, is one of 20 Community Support Workers employed by Sheffield City Council. She met Walter, 87 from near Hillsborough, when he was referred to her by his GP surgery.

Karen said: “When I first met Walter he was very lonely. He was a big user of health services but his needs weren’t all medical.

“Walter needed help with really practical things that he couldn’t do by himself and this was getting him down. He needed a hair-cut – this was really important to him as he’s an ex-Navy man so it’s important for him to be smart.

“So I arranged for a mobile hairdresser to come out to him. She’s now stopped hairdressing but still visits Walter and cuts his hair. She’s turned into a friend of his so it means he now has someone else to visit him which he really likes.

“It’s really practical things I’ve helped with but it has made a difference.

“I can go months without Walter contacting me but he knows I’m there if he needs anything. He’ll phone me if he’s worried about something and I’ll either pop in to see him or we speak on the phone. This can just take a few minutes but it’s all it needs.

“Since I’ve been seeing Walter he’s never been in hospital once, he’s never phoned 999 or called out the doctor. He’s a more settled person. He’s not reliant on me but knows he can call if he needs to – I just helped by finding a solution to his problems.”

Walter said: “Before I got to know Karen things were not so good.

“Having Karen here has been a big change in my life – to have someone who I can go to for advice when I need it.

“Karen has helped me with my post and forms and things like that, that I can’t cope with. She also got me this nice hairdresser that comes to me now and I get a hair-cut and a beard trim and she’s nice company.”

Walter is one of many people across Sheffield who has been benefiting from more joined up health and social care. More joined up work will increase through the city’s £271m Better Care Fund which has been agreed by Sheffield City Council and NHS Sheffield Clinical Commissioning Group.

The £271m fund is one of the biggest pooled health and social care budgets in England. It is being discussed at the Council’s cabinet meeting on Wednesday, 27 May.

Councillor Mary Lea, Cabinet Member for Health, Care and Independent Living, said: “We can get more for our money by joining up health and social care services. We are committed to this and the size of our pooled budget shows just how much.

“We want to help people stay well and healthy at home and make the most of community support. Working in a joined up way means we can get rid of budget restrictions that can get in the way of this.”

The Council and CCG’s innovative plans have already been recognised by Government who awarded an extra £1 million funding last year (November 2014) through its Transformation Challenge Award.

Dr Zak McMurray, GP and NHS Sheffield CCG Medical Director said: “By combining our work and pooling our budget patients will now benefit from a greater connectivity between health and social care services and this will positively enhance their experience of treatment and care within Sheffield.

“Patients will start to see more care services being brought closer to their homes as we look to provide earlier treatment in the community and better support within people’s home to prevent them needing emergency care in hospital or care homes and to reduce unnecessary hospital admissions.”

Additional information:

More information about the Better Care Fund is available in the Council’s report to cabinet on Integrated Commissioning of Health and Social Care.

Community Support Worker posts are employed by Sheffield City Council and funded by the Council and NHS Sheffield Clinical Commissioning Group.

They are based in GP practices. If a GP or District Nurse identifies someone with a non-medical issue which means they may be at risk of going into hospital, they refer them to a Community Support Worker. Most people referred are:
• Elderly
• Suffering from loneliness and isolation and/or anxiety or depression
• Some are struggling to cope at home/to maintain their home as they would like to.
• Often older people recently bereaved are referred – e.g. men who don’t know how to cook or use the washing machine.

Community Support Workers visit people, have a chat to them, find out what their issues are and help them. The amount of contact they have with people varies – the majority just need one visit but this varies depending on what people need.

An aim behind Community Support Workers is to be proactive at trying to identify people who are one step away from a crisis or from needing more intensive support. By providing help at an earlier stage we hope to keep people independent for longer. Everyone seen by a Community Support Worker is given a fridge magnet which their contact phone number on it. This is so people can contact them if they need help.

The Council currently employ 20 Community Support Workers up from eight the previous year. This is increasing to 26 from June 2015. In the last year the support workers saw 1,500 people.